Order: Social Intelligence Profile - Professional Trial Version

I request authorization for the Professional Trial version of Karl Albrecht International's Social Intelligence Profile (on-line version). I understand that acceptance of my request is contingent on a review of my professional qualifications (as provided below or otherwise supplied), and that enrollment may be refused to applicants who are judged unsuitable.

If accepted, my credit card will be charged USD $50.00. I will receive a confirmation and my temporary ID Code and Password by email. I understand that, once I access the Online SI Profile my fee is not refundable.

I understand that the fee for access to this trial version is applicable to the full certification fee if I decide to enroll as a Certified User within 30 days.

All (*) fields are required
(*) Last Name
(*) First Name
Title / Department
(*) Company
(*) Street Address (No P.O. Boxes)
(*) City
(*) State/Province (2-letter State Code for US)
(*) Zip/Postal Code
(*) Country
(*) Email
Gender Male Female

(*) In One Paragraph (1000 characters),
please summarize your professional qualifications here
(current occupation, organization, credentials, experience, business operation, etc.):

How did you first discover the Social Intelligence Profile?

 (*) I confirm that I will adhere to the ethical use guidelines for using KAI profile products.

Secure Server: Choose method of Payment:
Visa  MasterCard  AmEx 
Name (Exactly as on Card)
Billing Address (As on Account)
Zip/Postal Code
Card Number (No spaces or dashes)
Exp. Date (mm/yy)
Authorization Code (3 or 4 digits, required)
Priority Code, If Available

To prove you're a human, please answer the following:
What language do people in Australia speak?

(Reload/refresh the form to get a new question)